How Is Creativity Differentially Related to Schizophrenia and Autism?

"There is only one difference between a madman and me. I am not mad." -- Salvador Dali

For some reason, the general public is fascinated by the link between madness and genius. A new paper, which has been garnering a lot of media attention, has stoked the flames once again on this age-old debate.

The paper shows a link between artistic engagement and the genes underlying schizophrenia and bipolar disorder. To be sure, the effects are really small (the genes explain less than 1% of the variation in choosing an artistic profession), and the results do not mean that if one has a mental illness they are destined for creativity (or that creative people are destined for mental illness). Nevertheless, the results are consistent with other solid studies showing there is a real and meaningful link between the schizophrenia spectrum and artistic creativity (see here, here, here, and here). Indeed, the supplemental data shows that the strongest relationships are between the genes underlying schizophrenia and engagement with music, the visual arts, and writing.

This past year, I conducted a relevant study with a stellar Penn undergraduate for her independent study project.* Julia Masters, who studies psychology and is also a visual artist, was curious how different spectrums might be related to different forms of creativity. Toward this aim, we had 204 participants complete an extensive battery of cognitive and personality tests. We focused on relationships with two particular spectrums: the schizophrenia spectrum and the autism spectrum.

Recent research, from a variety of perspectives-- genomics, neurodevelopment, psychology, psychiatry, and evolutionary biology-- suggests that there are partially-overlapping etiologies and diametric causes of both autism and schizophrenia. What Julia and I wondered is whether we could meaningfully separate the unique aspects of both spectrums in a non-clinical setting and whether these aspects are differentially related to different forms of creativity.

We began with the assumption that mental disorders are not categorical. Outside the narrow confines of the clinical setting, we see that all of us lie somewhere on every spectrum (e.g., schizophrenia, autism, mood disorders, etc.). In the general population, it makes more sense to refer to autistic-like or schizophrenia-like characteristics and behaviors, rather than labeling people with a mental illness (actually, I'd prefer to not label people at all if I had my choice).

So what did we find?

To start seeing the big picture, we employed a statistical technique called factor analysis to simplify all of the characteristics of the schizophrenia and autism spectrums into a more managable set of factors. Emplying this technique, we were able to reduce all of the characteristics to two main factors.

The first factor included a mixture of characteristics typically associated with autism spectrum disorder as well as characteristics typically associated with "negative schizotypy":

Low social skill("I prefer to do things with others rather than on my own", "I find it hard to make new friends")

Constricted affect("I do not have an expressive and lively way of speaking", "I am poor at returning social courtesies and gestures")

No close friends ("I prefer to keep myself to myself", "I tend to keep in the background on social occasions")

Low communication (e.g., "I frequently find that I don't know how to keep a conversation going", "When I talk on the phone, I'm not sure when it's my turn to speak")

Low attention switching ("I prefer to do things the same way over and over again", "I frequently get so absorbed in one thing that I lose sight of other things")

Excessive social anxiety (e.g., "I get very nervous when I have to make polite conversation", "I feel very uncomfortable in social sitautions involving unfamiliar people")

We labeled this factor "ASD [Autism Spectrum Disorder]/Negative Schizotypy". It's clear that this factor is very interpersonal in nature, and is consistent with prior research showing that the strongest relationships between autism and schizophrenia are in the interpersonal domain. Note that the imagination items on the scale really refer to a specific kind of imagination: social imagination. There are, of course, other kinds of imagination (e.g., visuo-spatial imagination). The sort of imagination that is measured by this test is most likely dependent on the "default mode" brain network, which tends to be underactive in people with autism.

The second factor included a mixture of characteristics that are typically associated with "positive schizotypy":

Odd beliefs or magical thinking (e.g., "Do you believe in telepathy?", "Have you had experiences with astrology, seeing the future, UFOs, ESP, or a sixth sense?")

Ideas of reference (e.g., "Do you sometimes feel that other people are watching you?", "Do you sometimes see special meanings in advertisements, shop windows, or int he way things are arranged around you?")

Unusual perceptual experiences ("Have you ever had the sense that some person or force is around you, even though you cannot see anyone?", "When you look at a person, or yourself in a mirror, have you ever seen the face change right before your eyes?").

Attention to detail ("I tend to notice details that others do not", "I notice patterns in things all the time", "I am fascinated by numbers")**

It's clear that this factor is cognitive-perceptual in nature. This finding is consistent with prior research showing that the clearest and most stark demarcation between the autism spectrum and the schizophrenia spectrum is in the cognitive-perceptual domain of functioning.

Finally, we found that three subscales were equally relevant to ASD/Negative Schizotypy and Positive Schizotypy:

Most certainly, the nature of the speech differs between the spectrums, with schizophrenia relating more to speech that is vague, circumstantial, metaphorical, and over-elaborate, and autism relating more to abnormal non-vocal communication behaviors, such as impairment in the use of non-verbal cues and body language (e.g., eye contact).

If you're interested in the actual factor loadings, here they are:

In terms of personality, Positive Schizotypy was associated with openness to experience, whereas ASD/Negative Schizotypy was more strongly related to neuroticism, introversion, disagreeableness, and low conscientiousness. The relationship between positive schizotypy and openness to experience is consistent with other research showing a strong link between apophenia (the tendency to see patterns that don't exist in reality, a synonym for positive schizotypy) and openness to experience. The very strong relationship between the autism spectrum and the introversion spectrum is reminiscent of Jennifer Grimes' controversial hypothesis that introversion and autism can be placed on the same spectrum.

Now let's dive into the creativity findings. Those scoring higher in positive schizotypy tended to score higher in creative self-efficacy, creative personal identity, and creative self-concept. Those scoring higher on ASD/Negative Schizotypy showed the opposite pattern. From this data it's clear that people with autistic-like characteristics do not tend to view themselves as particularly creative. Creativity is just not as central an aspect of their identity as it is for people with schizophrenia-like characteristics.

Positive Schizotypy was also positively related to artistic pursuits, whereas ASD/Negative Schizotypy was negatively related to artistic pursuits. Therefore, it seems that those on the autism spectrum aren't as interested or motivated to engage in artistic activities compared to those on the schizophrenia spectrum. This is consistent with the above-mentioned genetics study, which found that the strongest relationship was between schizophrenic genes and artistic engagement.

These findings suggest to me that the genes that link schizophrenia with artistic creativity are the genes that influence dopamine production and function, considering dopamine's role in cognitive exploration. There appears to be a sweet spot of dopamine, in that too little or too much dopamine production is detrimental to the generation of creative ideas. Artistic creativity is particularly well suited for individuals who are constantly in overdrive and need an outlet to explore a wide range of ideas, sensations, and emotions. This may also be why we see a link between bipolar disorder and creativity: hypomania and idea generation are positively associated with each other, and with dopamine production (see here, here, and here).

This does not mean, however, that the only form of creativity that matters is that of the artistic variety. Indeed, these studies that focus too much on artistic creativity may unfortunately be ignoring the real and important ways creativity can play out in other domains (e.g., biology, physics, math, business, humanitarian fields).***

Of course, these are just general trends. There are plenty of art lovers who are high on the autistic spectrum and plenty of people high on the schizophrenia spectrum who love the sciences. What's more, it is possible to score sky high on both spectrums. Indeed, these individuals may have the best of all worlds-- the attention to detail, passionate singular interest, social nonconformity, imagination, and the ability to access altered states of consciousness. Many geniuses-- including Einstein, Mozart, Newton, Darwin, and Michelangelo-- have been suspected of crossing spectrum lines, so to speak, by displaying all of these characteristics.

So yeah, creative people have messy minds. But that doesn't mean they have a mental illness.

Here's to the oddballs, for they are the ones who fundamentally change our world.

** It's easy to imagine how a person with strong schizophrenic-like traits may ensorse the attention to detail items for a completely different reason than why a person with strong autistic-like traits would endorse the very same items! People high on the schizophrenia spectrum may endorse them because they see mystical numerological connections between them, while the person on the autistic spectrum might be fascinated with numbers and patterns in a mathematical, very structured sense.

*** Interestingly, in our sample the autism spectrum wasn't associated with creative achievement in the sciences. We expected this based on prior findings. Perhaps this lack of an association between the autism spectrum and scientific achievement is due to the nature of our sample (e.g., maybe they aren't old enough to achieve at a high level).

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